Life-threatening delayed arterial hemorrhage following anterior cervical spine surgery: A case report and literature review
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Sergio Pansini, Naples, Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
- Department of Neurological Surgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
- Department of ENT, Ospedale Bellaria, Bologna, Italy.
Department of Neurological Surgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
DOI:10.25259/SNI_225_2020Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Giovanni Miccoli, Emanuele La Corte, Ernesto Pasquini, Giorgio Palandri. Life-threatening delayed arterial hemorrhage following anterior cervical spine surgery: A case report and literature review. 23-May-2020;11:124
How to cite this URL: Giovanni Miccoli, Emanuele La Corte, Ernesto Pasquini, Giorgio Palandri. Life-threatening delayed arterial hemorrhage following anterior cervical spine surgery: A case report and literature review. 23-May-2020;11:124. Available from: https://surgicalneurologyint.com/surgicalint-articles/10043/
Background: One of the most serious and potentially life-threatening adverse events associated with anterior cervical spine surgery is postoperative hematoma with acute airway obstruction. The causes of unpredicted delayed bleeding are, however, not fully elucidated. Here, we report a case of delayed arterial bleeding and sudden airway obstruction following a two-level ACDF.
Case Description: A 52-year-old male presented with the right paracentral disc herniations at the C4–C5 and C5–C6 levels. A two-level ACDF was performed. Notably, on the 5th postoperative day, the patient developed an acute respiratory distress due to a large right lateral retrotracheal hematoma requiring emergency evacuation at the bedside. This was followed by formal ligation of a branch of the right superior thyroid artery in the operating room. In addition, an emergency tracheotomy was performed. By postoperative day 15, the tracheotomy was removed, and the patient was neurologically intact.
Conclusion: A superior thyroid artery hemorrhage should be suspected if a patient develops delayed neck swelling with or without respiratory decompensation several days to weeks following an ACDF. Notably, these hematomas should be immediately recognized and treated (i.e., decompression starting at the bedside and completed in the operating room) to prevent catastrophic morbidity or mortality.
Keywords: Anterior cervical discectomy and fusion, Delayed hemorrhage, Superior thyroid artery
Anterior cervical discectomy and fusion (ACDF) is one of the most commonly performed spinal operations.[
Scopus and PubMed databases were queried using individual keywords and MeSH terms for identifying postoperative ACDF hematomas due to superior thyroid artery branch dissections.
A 52-year-old male presented with bilateral cervicobrachialgia, bilateral arm paresthesias, and tetraparesis. The magnetic resonance imaging showed the right paracentral disc herniations at the C4–C5 [
Anterior cervical spine operations are among the most commonly performed procedures among spine surgeons and have low complication rates.[
Etiology of superior thyroid artery dissection
The etiology of superior thyroid artery dissection in our case remained unclear. Yu et al.[
Time of onset of postoperative hematomas due to ACDF
Most vascular arterial complications of ACDF are detected intraoperatively or in the early postoperative period.[
Delayed arterial bleeding leading to postoperative ACDF hematomas
Few cases report delayed arterial postoperative hematomas after ACDF. In our patient, the postoperative hemorrhage from a branch of superior thyroid artery was encountered on the 5th postoperative day. One report in the literature cited a hemorrhage following a C34/C45 ACDF as occurring 16 days postoperatively; it too was due to a superior thyroid artery dissection.[
Retropharyngeal hematomas are rare following anterior cervical surgery. They typically present acutely, within 6–12 postoperative hours, and occasionally from 3 to 7 days to up to 1 month postoperatively. Here, we presented a patient with a retrotracheal hematoma occurring 5 days following a C45/56 ACDF attributed to a hemorrhage from a branch of the superior thyroid artery.
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